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Suggest Treatment For Hypertension

Posted on Mon, 27 Apr 2015

Question: Hi
I am 48, male and am suffering from hypertension (just diagnosed last month) - my reading taken last month was 169/105. I am a vegetarian, non smoker but drink about 150 ml of alcohol or 3 pints 5 days a week. I had a previous episode of gout which was treated with Allopurinol and i continue to take 200 mg daily with about 4 litres of fluids consumed everyday. (so i have a bit of water retention)
I am 5 ft 10 inches tall and weigh 73 kgs - so not fat or obese.
My father died at an age of 50 with a heart attack - though he was a teetotaler and non smoking vegetarian.
I have had a couple of headaches since the diagnosis and am now worried about a stroke and want to get on medication.
I am fully insured and can go to a private hospital anytime but want to know some basics about different types of medication before i go there :

1 What is the preferred type of medication for my case - Ace Inhibitors, Beta blockers, Calcium channel blockers or diuretics - and if a combo, what would be a preferred combo. Pls remember that i take allopurinol
2 Alcohol - how much should i reduce consumption to be relatively safe
3 Apple cidar vinegar with Baking soda - recommended in addition to medication - or Baking soda is not good for me

Answered by Dr. Sandip Kabra (2 hours later)

Brief Answer:
Must avoid alcohol and start with calcium channel blockers.

Detailed Answer:
Hi Mr.XXXX,

Welcome to health care magic,

First of all,if your blood pressure reading was 169/105 with considering your family history of heart problem and alcoholism,you must undergo routine blood tests,liver function tests,creatinine,lipid profile,ECG, 2D-echocardiography of heart and tread mill test (when blood pressure comes normal) to check the heart status.(As you are also having medical insurance)

You must avoid further intake of alcohol because it might cause some ill effect on cardiovascular system.

Your anti-hypertensive medication will vary according to physician's choice and will depend upon the above investigations.

I would advise to start with calcium channel blocker(amlodipine) or ACE inhibitors like enalapril with salt restricted diet and some life style modifications.

You must consult physician for further advise on anti-hypertensive medications.

You can continue with your allopurinol for your gout treatment.

Apple cidar vinegar with Baking soda has no use or effect on hypertension.

You do not need to worry about stroke as just a headache never can cause stroke.You can take proper analgesic for that.

You must consult physician for thoroughly clinical examination and treatment.

Above answer was peer-reviewed by : Dr. Neel Kudchadkar

Follow up: Dr. Sandip Kabra (8 minutes later)

Thanks for this

What about Beta blockers and diuretics? Why are they not recommended?

What is recommended dosage for ACE inhibitors ? And what would be a suitable combination therapy with them? Diuretics? Beta blockers?

Thanks

Answered by Dr. Sandip Kabra (4 hours later)

Brief Answer:
We should start with CCBs or ACE inhibitors.

Detailed Answer:
Hi XXXX,

Thanks for follow-up query.

In a new diagnosed case of hypertension, we generally starts antihypertensive medications with either calcium channel blockers (amlodipine) or ACE inhibitors(enalapril) as per physician's choice with regular monthly follow-up and to check for the response of this drugs on blood pressure.

Diuretics causes hyperuricemia or gout by increasing uric acid level in blood, so in your case they are not suppose to be given.

Beta blockers are good but should be used in long term maintenance cases of blood pressure control and it depends on your further cardiac evaluation reports.

You must undergo all the investigations what I have mentioned earlier and consult physician or cardiologist for further treatment.

Thanks,
Dr.sandipkabra

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Above answer was peer-reviewed by : Dr. Vaishalee Punj